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What can we do to get a beautiful smile?

 Dr. Katrin Paberit, orthodontist at Merimetsa Hambakliinik

A pretty smile lights up the whole room, does it not? The foundation for it is laid in a very early age. In addition to a pretty smile, the normal functioning of the teeth is also very important.  The causes of improperly positioned teeth can be either genetic or acquired. We cannot do much about the genetic causes. Of course, every pregnant woman should be very careful about their health and avoid exposure to dangerous substances. There are many medications and chemicals that can cause damage to the foetus, including the development of the jawbones and teeth. However, many of the problems that orthodontists deal with are acquired and, therefore, preventable. Though it is not always possible to completely prevent the need for orthodontic treatment, but it is still possible to prevent serious anomalies. If a child only needs minimal corrections, the treatment takes less time and money and often gives better results than a very complicated treatment.

The first visit to the dentist should happen between the age of 1 and 1,5 when not all of the 20 „baby teeth“ have erupted. The goal is to prevent, not treat, dental diseases, which is why you should not wait until problems appear. To acquaint the child with the clinic and its personnel, you might want to bring him/her with you to your own shorter visits to the dentist. Once the child is familiar with the surroundings, it is possible to check his/her teeth trough games. This way, the child gets used to this and will not be afraid to regularly show his/her teeth to the dentist. The most important thing about these visits is that the parents, too, find out how to take better care of their children’s teeth. How, when and with what should they wash the teeth; what should the child drink etc. At first, the development and eruption of primary teeth will be monitored by a dentist.

The first visit to an orthodontist should take place at the age of 7 or 8. Ensuring a good oral hygiene and eliminating bad habits such as breathing trough the mouth, sucking the thumb, sucking the pacifier too long (usually there is no permanent damage when stopped before the age of 2) or chewing a pencil is essential from an orthodontic perspective. The normal development of teeth and jawbones is ensured by the surrounding muscles. All the muscles responsible for chewing should be in balance so that the jawbones and teeth could develop and grow correctly.  All deviations from that balance cause changes in the jaws. Because of this, it is very important to ensure that the child can breathe through the nose. If the child constantly breaths through the mouth, the development of the jawbones is affected. The tongue is a muscular organ that should mould our teeth from the inside and it should be balanced by the pressure from the cheeks and lips from the outside. If one breathes through the mouth, the tongue lies at the bottom of the mouth, not at the palate, and the cheeks push the teeth inside. The mouth is opened and the front teeth lean forward. This also dries the teeth and the lack of the protection normally provided by saliva increases the risk of caries. In addition, the inhaled air is neither cleaned nor warmed (as it is when one breathes through the nose.) Therefore, the problems caused by breathing through the mouth are numerous.

Lahihambumus

Result of long-term thumb sucking.

Long-term thumb sucking can cause serious problems, too. It disturbs the balance of the muscles, in addition, the hand places pressure on the lower jaw pushing it backwards and downwards. The thumb, in turn, pushes the lower teeth inside and the upper teeth outside, causing a malocclusion where the lower and upper teeth have no contact; this, in turn, impedes biting. Children usually suck their thumbs in order to calm themselves. This habit may develop during breastfeeding, after being weaned from the pacifier, or due to stress. If the family is having rough or stressful times, the child senses that and starts sucking on his/her thumb to calm him/herself or to fall asleep. The first step should be detecting the cause. Sometimes a simple distraction will solve the problem, in more serious cases, however, it may be necessary to see a children’s psychologist.

When it comes to oral hygiene, developing the correct habits in an early age is crucial for various reasons. Firstly, all adults know how hard it is to break old habits. The foundation for good habits is laid in the childhood. It is very important to start brushing teeth twice a day (morning and night) as soon as they appear.  The child will get used to this and already by the age of two the child will not think of going to bed without brushing. There is nothing wrong with eating sweets as long as the portions are controlled, the child has first developed the habit of eating healthy food as his/her primary nutrition, and the teeth are being brushed regularly. It is very sad to see parents who believe that primary teeth do not need to be cleaned or treated since they will be replace by permanent teeth. We already discussed the importance of good habits, but it is also very important to know that the state of the primary teeth also has an effect on the permanent teeth, plus chronic root infections of the primary teeth are a danger to the general health of a person. The health of primary teeth is also important from an orthodontic point of view. To be more exact, the primary teeth keep space, both in height and width, for the permanent teeth. Primary teeth usually erupt between the age of 6 months to 2,5 years and permanent teeth between 6 and 13 years of age. This means, that if we, for example, need to extract a tooth of a three-year-old due to extensive caries, it might take up to 10 years until it is replaced by a permanent tooth. But during those 10 years the child still needs teeth for chewing and keeping places for permanent teeth. Extracted primary teeth cause crowding once the permanent teeth start appearing and this is one of the most common problems that we need to treat with braces.

Photo of no room for permanent tooth.

The arrow points to the place where a baby tooth was lost in a young age and now there is no room for the permanent tooth.

Good oral hygiene is also important if the child does need orthodontic treatment and an appliance is installed. In case of fixed appliances such as braces, keeping your teeth properly cleaned is especially difficult. It is essential to keep the surface of the tooth from around the braces clean. Here, the help of a dental hygienist is very important. All children who are having problems with oral hygiene and most patients with braces should see a dental hygienist, who will clean their teeth and teaches proper techniques for cleaning them yourself, on a regular bases. Unfortunately, we do not have enough dental hygienists in Estonia and people are not yet used to seeing them like they are in Scandinavia, where people’s dental health is very good largely thanks to that. But the situation seems to be improving. In addition to dentists, we also have a dental hygienist Maarja Paberit working in our clinic and our experience shows that many children who struggle with keeping their teeth clean benefit from this cooperation.

Children are our future so let’s take care of them like they deserve and do everything we can to ensure them a future with healthy teeth and a beautiful smile!

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